What are syringe services programs?

Syringe Services Programs (SSPs) provide low-barrier access to sterile supplies for safer substance use, naloxone and overdose prevention tools like fentanyl test strips and drug checking services. SSPs also provide a range of other services, such as options for safe syringe disposal, overdose recognition and response training and help accessing services for HIV, substance use disorders and more.2,3

Community-based SSPs are often led by people with lived experience of substance use who are committed to a harm reduction philosophy and foster a non-judgmental environment for people who are seeking support for their substance use but face discrimination, financial barriers or other challenges when interfacing with other healthcare institutions.2

“High-quality syringe services programs can prevent the spread of disease, save lives, and connect people to other health services, including treatment for substance use disorder.” 

–Dr. Rahul Gupta, Director of the Office of National Drug Control Policy1

What evidence supports SSPs as a public health strategy?

The evidence that SSPs prevent overdose is so great that the CDC has endorsed SSPs as one of the most effective, scientifically proven prevention strategies.2

SSPs prevent overdose. SSPs are very effective at providing low barrier access to evidence-based overdose prevention tools, like naloxone4 and fentanyl test strips.5,6  SSPs are also very effective at linking people to medication for opioid use disorder (MOUD), which reduces the risk of overdose.7,8

SSPs link many people to substance use disorder treatment. Studies have found that people who participate in local SSPs are significantly more likely to enter treatment for substance use disorder compared to those who do not.7,9,10 Many SSPs collaborate with healthcare providers to offer MOUD treatment in-person or via telehealth.

SSPs reduce substance use. As many as 4 in 5 SSP participants are interested in reducing or ceasing their substance use.9 SSP participants are more than twice as likely to reduce the frequency of their substance use and more than three times as likely to stop using substances entirely compared to those who do not.10

SSPs prevent disease. Access to sterile supplies significantly reduces the transmission of infectious disease, such as HIV and hepatitis C, and prevents potentially life-threatening bacterial infections causing abscess, endocarditis and sepsis.2

SSPs reduce crime and make neighborhoods safer. SSPs reduce the amount of syringe litter in the neighborhoods where they operate by providing multiple options for safer disposal.11,12 SSPs do not increase or promote criminal activity13,14 and have been linked to crime reduction in cities like San Francisco.15

Are there risks to my community or institution if we don’t support SSPs?

Yes. More fatal overdoses may occur. Though it is possible to obtain naloxone through other means, such as a physician or pharmacy, research is clear that SSPs are the most effective way to distribute naloxone to those most likely to save a life by using it. One study found that pharmacies would have to distribute more than twice as many naloxone kits as community-based SSPs to prevent the same number of overdose fatalities.4

HIV outbreaks may occur. Recent HIV outbreaks in Indiana, Massachusetts and West Virginia have been linked to local policies restricting access to SSPs (such as limited hours, proof of residency requirements, distribution limits or outright SSP bans).16–18 In addition to being a serious public health crisis, HIV outbreaks are expensive: each new case costs more than $350,000 to treat over a single lifetime.19

Fewer people will access treatment for substance use disorders. SSPs are the most effective and well-trafficked pathway to effective treatment for substance use disorders. People who utilize SSP services are many times more likely to begin treatment, stay in treatment and cease substance use than those who do not.7–10

What are some examples of successful SSPs?

The Eastern Band of Cherokee Indians established the Tsalagi Public Health SSP in 2018. In addition to providing access to sterile supplies and naloxone, the SSP has linked nearly 1 in 14 participants to treatment for substance use disorders.34

Sonoran Prevention Works (SPW) is a nonprofit harm reduction organization founded by people who use drugs. In addition to operating three urban service locations, SPW conducts community-informed outreach programs in Arizona’s southern and rural counties. In 2021, SPW trained over 1,000 individuals in harm reduction best practices for overdose prevention and naloxone administration in Cochise, Graham and Santa Cruz counties and distributed nearly 2,500 naloxone kits in these communities.35

Prevention Point Philadelphia is an SSP in Philadelphia’s Kensington neighborhood. In addition to other essential public health services, like access to naloxone and sterile supplies for safer substance use, Prevention Point also offers MOUD treatment onsite.36

The North Carolina Harm Reduction Coalition offers mobile SSP services in several North Carolina counties, expanding access to rural areas of the state where community members face long travel times and other barriers to seeking services often clustered in urban areas.37

These and many other model programs are described online at the Brandeis Opioid Resource Connector

Learn More

Additional Resources

Implementation Guidelines and Best Practices
Legal and Legislative Tools

National Harm Reduction Technical Assistance Center (NHRTAC)

The NHRTAC was established by the U.S. Centers for Disease Control and Prevention and the U.S. Substance Abuse and Mental Health Services Administration to provide free assistance to those implementing harm reduction services in their community. Technical assistance for implementing SSPs may be requested through the NHRTAC website. 

Learn More

Rural Health Information Hub (RHIhub)

On its website, RHIhub hosts a toolkit to support community leaders in establishing SSPs, including considerations for program planning, implementation, and evaluation.

Learn More

National Association of State and Territorial AIDS Directors (NASTAD)

NASTAD provides technical assistance for the implementation of SSPs to health departments and community-based organizations. They also provide regional harm reduction support through a network of professional consultants working across the United States as well as regional SSP technical assistance call series.

Learn More

Author, Jennifer J. Carroll, PhD, MPH

Approved Strategies

The two largest opioid settlements include requirements on how funds can be spent. Learn more about approved uses of the funds that are high-impact and under county authority.

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Syringe Services Programs

Syringe Services Programs (SSPs) provide low-barrier access to sterile supplies for safer substance use, naloxone and overdose prevention tools like fentanyl test strips and drug checking services.

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Effective Treatment for Opioid Use Disorder for Incarcerated Populations

Medication-assisted treatment is considered the “gold standard” of care for opioid use disorder (OUD). The FDA has approved three medications for treating OUD: methadone, buprenorphine and naltrexone.

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Treatment and Recovery for Pregnant and Parenting People

During pregnancy, the evidence-based standard of care for opioid use disorder (OUD) is treatment with methadone or buprenorphine. 


  1. The White House. White House Releases Model Law to Help States Ensure Access to “Safe, Effective, and Cost-saving” Syringe Services Programs. The White House. Published December 8, 2021. Accessed October 7, 2022. https://www.whitehouse.gov/ondcp/briefing-room/2021/12/08/white-house-releases-model-law-to-help-states-ensure-access-to-safe-effective-and-cost-saving-syringe-services-programs/
  2. Carroll JJ, Green TC, Noonan RK. Evidence-Based Strategies for Prevention Opioid Overdose: What’s Working in the United States. Published online 2018. Accessed October 10, 2018. http://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf
  3. Carroll JJ, Asher A, Krishnasamy V, Dowell D. Linking People with Opioid Use Disorder to Medication Treatment. Published online 2022. Accessed June 8, 2022. https://www.cdc.gov/drugoverdose/pdf/pubs/Linkage-to-Care_Edited-PDF_508-3-15-2022.pdf
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  15. Davidson PJ, Lambdin BH, Browne EN, Wenger LD, Kral AH. Impact of an unsanctioned safe consumption site on criminal activity, 2010-2019. Drug Alcohol Depend. 2021;220:108521. doi:10.1016/j.drugalcdep.2021.108521
  16. Peters PJ, Pontones P, Hoover KW, et al. HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014–2015. New England Journal of Medicine. 2016;375(3):229-239. doi:10.1056/NEJMoa1515195
  17. Cranston K, Alpren C, John B, et al. Notes from the Field: HIV Diagnoses Among Persons Who Inject Drugs — Northeastern Massachusetts, 2015–2018. MMWR Morb Mortal Wkly Rep. 2019;68. doi:10.15585/mmwr.mm6810a6
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  19. Schackman BR, Fleishman JA, Su AE, et al. The Lifetime Medical Cost Savings From Preventing HIV in the United States. Medical Care. 2015;53(4):293-301. doi:10.1097/MLR.0000000000000308
  20. Singer JA, Heimowitz S. Drug Paraphernalia Laws Undermine Harm Reduction. Cato Institute. Published June 7, 2022. Accessed June 14, 2022. https://www.cato.org/policy-analysis/drug-paraphernalia-laws-undermine-harm-reduction-reduce-overdoses-disease-states
  21. Green TC, Martin EG, Bowman SE, Mann MR, Beletsky L. Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences With Federal Funding. Am J Public Health. 2012;102(5):e9-e16. doi:10.2105/AJPH.2011.300595
  22. Javed J, Burk K, Facente S, Pegram L, Ali A, Asher A. Syringe Services Programs: A Technical Package of Effective Strategies and Approaches for Planning, Design, and Implementation. US Department of Health and Human Services, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease, Control and Prevention; 2020. Accessed September 5, 2022. https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf
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  25. Kral AH, Anderson R, Flynn NM, Bluthenthal RN. Injection risk behaviors among clients of syringe exchange programs with different syringe dispensation policies. J Acquir Immune Defic Syndr. 2004;37(2):1307-1312.
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